This brief article will give you the lowdown on what exactly is meant by a “shoulder arthroscopy” surgery, also termed “shoulder scope.”
Shoulder arthroscopy is a type of advanced surgery which utilizes specialized equipment and small incisions (each incision is just a couple of millimeters) to allow the surgeon to treat injuries with minimal surgical trauma to the patient. The special equipment consists of a camera (called an "arthroscope") with varying angles at the tip and a pump system. The camera displays video images on a monitor and the surgeon uses these images in real-time to guide her as she operates specialized miniature instruments. Arthroscopy technology allows the surgeon to see everything inside the shoulder joint and frequently allows better visualization of the inside of the shoulder than what can be achieved with a conventional large incision.
Optimal visualization during arthroscopic surgery is accomplished through the use of an arthroscopic pump. The pump introduces sterile fluid into the inside of the shoulder, opening up space for the surgeon to see and to operate. The pump maintains a safe pressure that lets the surgeon see while making sure that the patient is safe.
To start the procedure, the surgeon typically makes a very small incision and then inserts a small plastic cannula through that incision. The cannula is a portal that is then used throughout the surgery to safely introduce instruments and specialized implants into the shoulder. All of arthroscopic shoulder instruments are designed to go through these cannulas and to function within the close quarters inside the shoulder. Rotator cuff repairs, debridements, labral repairs, and removal of loose bodies (to name just a few procedures) can all be performed through these small portals. The instruments can be inserted repeatedly without any injury to the soft tissue.
Cannulas used during shoulder arthroscopy
When the procedure is completed, all of the instruments are removed from the shoulder and the cannulas are then removed as well. The portal incisions are typically each closed with a single suture and then a small waterproof dressing is placed to cover the incision.
Examples of instruments used during various shoulder arthroscopic procedures.
Dr. Jurek performs many surgeries such as rotator cuff repair surgery and labral repair surgery arthroscopically and has undergone specialized training focused specifically on these advanced techniques. If you are interested in seeing some examples of what she sees and does during a shoulder arthroscopy surgery, check out her Instagram page for pictures and videos.
You've Just Been Told You Need a Shoulder Replacement. Here Are Answers To Questions You Forgot To Ask.
If you've seen Dr. Jurek or another orthopaedic shoulder surgeon who has recommended that you consider undergoing shoulder replacement surgery, here are answers to some questions you may have:
What exactly IS a shoulder replacement?
A shoulder replacement is a surgery that replaces the surfaces of a worn out or injured shoulder joint with very smooth, strong metal and plastic surfaces to treat severe shoulder pain and improve function of the shoulder.
Shoulder replacement surgery is considered an "open procedure" meaning that a small incision (usually measuring about 5 inches in length) is made and the surgery is performed through that incision.
There is more than one different type of shoulder replacement; the most common are 1) anatomic total shoulder arthroplasty and 2) reverse total shoulder arthroplasty.
Reverse total shoulder arthroplasty is something entirely unique to the shoulder and switches up the anatomic relationships completely. Another term for this surgery is "inverse articulation surgery" but most people just refer to it as a "reverse." In reverse total shoulder replacement surgery, the ball of the shoulder joint (the humeral head) is replaced with a metallic socket component and the socket/cup of the shoulder joint (the glenoid) is replaced with a metallic ball (also called a "glenosphere"). There are special circumstances when a reverse total shoulder arthroplasty is a better option (and sometimes, the only viable option) as a replacement. This is something Dr. Jurek will discuss with you at length if shoulder replacement surgery is recommended to you.
Why do I need a shoulder replacement?
There are many reasons why shoulder replacement surgery may be an excellent option for you.
One of the most common reasons why you need a shoulder replacement is that you have very severe arthritis of your shoulder and nonoperative treatment no longer adequately addresses your symptoms.
Many patients decide to have their shoulder replaced when they are having significant difficulties sleeping and/or doing their normal daily activities because of severe shoulder pain.
Other common reasons why shoulder replacement surgery is performed include: 1) treatment of certain shoulder fractures, 2) treatment of a shoulder with very large, irreparable rotator cuff tear (termed "cuff tear arthropathy") with severe shoulder pain and weakness, and 3) treatment of something called "avascular necrosis," which is when the blood supply to the shoulder fails and the bone dies as a result, causing severe shoulder pain.
What in the world is a reverse?? Why is it called that?
The first reverse shoulder arthroplasty was performed in France in 1985 by Dr. Paul Grammont and the first reverse replacement was performed in the US in 2004.
Will I be in a sling after surgery and if so, for how long?
The short answer is: yes, you will be in a sling after shoulder replacement surgery. The longer answer is: the length of time you will be in a sling postoperatively depends on which type of shoulder replacement surgery you undergo.
If you have anatomic total shoulder replacement surgery, Dr. Jurek will have you protect your shoulder in a sling for approximately 6 weeks. This time period allows the subscapularis tendon to heal which is very important in achieving a successful outcome.
If you have reverse total shoulder replacement surgery, Dr. Jurek will have you protect your shoulder anywhere from about 10 days to 4 weeks after surgery. The reverse allows a slightly more aggressive postoperative recovery program in general as compared to an anatomic total shoulder replacement.
When do I start physical therapy after a shoulder replacement?
When can I go back to work after a shoulder replacement?
Do I need to stay in the hospital overnight after my surgery?
The short answer to this question is: maybe.
The answer depends on a couple of factors:
1. Your particular health history and status. If you are very healthy and do not have any medical problems that would potentially require care in a hospital after surgery, you may be a good candidate for same day shoulder replacement surgery. On the other hand, if you have medical issues such as heart disease, diabetes, high blood pressure, or lung disease, it may be safest and best to perform your surgery in the hospital and have you stay overnight to ensure that you are safe to return home.
2. Your insurance. While this is slowly changing, many insurance companies will only cover a shoulder replacement surgery if it is performed in a hospital and the patient stays overnight. There are more and more insurance companies who recognize that certain patients do very well having their shoulder replacement surgery performed in a surgery center where they are able to go home the same day after their procedure.
3. Your preference. Some patients feel very strongly about either staying in the hospital overnight or going home the same day as surgery. Dr. Jurek will talk with you about your preferences and together you will come up with a plan tailored specifically to you and your situation.
If I have a shoulder replacement, will I set off metal detectors at the airport?
What will I be able to do once my shoulder is healed after having a replacement and more importantly, what won't I be able to do?
Once your shoulder is healed following shoulder replacement surgery, you will be able to do pretty much everything you want to do with your shoulder with a few important caveats. Especially initially, you may have some shoulder stiffness that will take time to resolve. It is possible that you may always have some limitations in range of motion following shoulder replacement surgery but usually these limitations do not compromise function or quality of life.
While Dr. Jurek does not put a discrete weight limit on how much you can lift after shoulder replacement surgery, you should not engage in heavy weight-lifting or repetitive high impact activities such as chopping wood following shoulder replacement surgery as this can cause loosening or failure of the implants. If you gradually build up the amount that you lift with your replaced shoulder, it is safe to lift heavy objects as long as you are able to safely control the load and protect your shoulder.
The surgery part of dealing with a shoulder injury frequently gets a lot of attention from both the patient and the surgeon, but it is typically the postoperative rehabilitation plan and program that dictates success (or failure) after a shoulder surgery.
The write-up below explains the four different phases of postoperative rehabilitation after a shoulder surgery. It is cited from AAOS 2017 Postoperative Orthopaedic Rehabilitation Chapter 5 Shoulder Instability Repairs.
In the immediate postoperative period, ROM is restricted. The primary goal of this phase is to prevent excessive scarring by allowing movement, but avoiding overaggressive motion that may compromise the surgical repair.
For example, after an anterior stabilization procedure, external rotation is restricted, as this may overstress the capsulolabral repair. Submaximal and subpainful isometric contractions are also initiated during phase 1 to stimulate muscle training, neuromodulate pain, and prevent muscle atrophy that occurs as a result of immobilization.
During this intermediate phase, the emphasis is on advancing shoulder mobility. Active assistive range of motion (AAROM) and PROM exercises are incorporated into the treatment program. The patient’s ROM and capsular end feel will be used to determine the rate of progression. Patients with sufficient ROM and a soft end feel will be progressed slower than a patient with restricted ROM and a hard end feel.
Joint-mobilization techniques are used to restore normal motion and to correct asymmetric capsular tightness. If one side of the capsule is excessively tight, the humeral head may translate in the opposite direction away from the tightness.
In an overhead athlete, the clinician will progress the stretching exercises to allow the athlete to obtain “thrower’s motion” of approximately 115° ± 5° ER to allow the athlete to return to throwing. Strengthening exercises can be progressed to include isolated rotator cuff and scapular exercises. Performing dynamic stabilization drills, manual resistance training, and proprioceptive neuromuscular facilitation (PNF) drills with rhythmic stabilizations can enhance neuromuscular control and reestablish muscular balance. During this phase, the “thrower’s ten exercise” program is typically initiated.
Phase III is designed to maintain shoulder ROM while improving strength, power, and endurance. Strengthening exercises are progressed to restore optimal sufficient muscle ratios. Muscular balance and dynamic joint stability should be achieved before initiating aggressive strengthening exercises, such as plyometrics or functional activities.
During this phase, eccentric muscle training and proprioceptive training are emphasized. Muscular endurance training also is performed to enhance dynamic functional joint stability and to prevent fatigue-induced subluxation. Plyometric training drills are utilized to increase the athlete’s functional mobility and to gradually increase the functional stresses onto the shoulder joint.
Overhead athletes are also progressed to the thrower’s ten program to improve strength, endurance, and posture during this period.
During this phase, the goal is to increase the functional demands on the shoulder and return the patient to unrestricted sport or daily activities. Upon successful completion of the rehabilitation program and achieving the desired goals, the patient may initiate a gradual return to sport activity in a controlled manner.
Other goals of this phase are to maintain the patient’s muscular strength, dynamic stability, and functional motion established in the previous phase. Therefore, the patient is encouraged to maintain a stretching and strengthening program on an ongoing basis to maintain optimal shoulder function.
*Exercise, in general, is good for you!
As a shoulder and sports medicine orthopaedic surgeon who does Crossfit four days a week, I am frequently asked if I feel like a hypocrite for doing something on a regular basis that commonly causes the very injuries I treat at work. I tend to answer something to the effect of “Yes, a little.” But then I expound on that admission by noting that I firmly believe that exercise is way better than no exercise and that anything can be dangerous if you don’t know what you’re doing, you’re not prepared for your task, or you are fatigued mentally and/or physically and you end up making poor choices as a result.
Dr. Jurek working hard outside of work
With those caveats in mind, there are certain injuries that tend to occur in Crossfit athletes. Here’s some general injury information and additional specific information on how to spot them.
When I see a patient in my clinic, I take his or her history, perform a physical exam, and frequently get imaging of the injured body part. I am first and foremost looking for what I think of as “red flag findings” – components of the history, imaging, or physical exam that cue me in to the possibility that a serious injury has occurred. Injuries with red flag findings typically present as sudden injuries where the athlete was completely fine and then suddenly wasn’t. A “pop” may have been heard and/or felt. At the time of the injury, there was a sudden inability to move or use the affected body part without extreme discomfort. Swelling typically occurs quickly. I frequently see patients with these stories who have persistent symptoms a couple of weeks out from their injury; I especially worry if their severe pain and disability has persisted despite rest and elevation and if they are having a hard time sleeping because of the pain. If you fall into this category after an injury, I highly recommend you see your health care provider to get checked out.
The most frequent injuries in Crossfit fall into the category of “overuse injuries.” These, too, can cause significant pain and disability, but they usually occur gradually over time. Typically, no one specific event or injury stands out to the patient; the pain and weakness just showed up and have not improved. Based upon my personal observation, the most frequently injured body part in terms of overuse Crossfit injury is the shoulder by far. Back pain/injury and knee injuries are next on the list.
Most Crossfit shoulder injuries involve irritation due to repetitive stress of the rotator cuff tendons, the biceps tendon, and the supportive ligaments of the shoulder. The shoulder joint is the most complex (and best :)) joint in the body with a lot of important structures that must all function perfectly together to work well without pain. If there is irritation or inflammation in the shoulder, this tends to set off a cascade of trouble that can result in persistent symptoms. Commonly, repetitive overhead lifting activities result in irritation and inflammation of the rotator cuff tendons (rotator cuff tendinitis or tendinopathy), irritation and inflammation of the bursa overlying the rotator cuff (subacromial bursitis), or a combination of the two. The biceps tendon is a structure separate from the rotator cuff that loves getting irritated with exercises common in Crossfit. Pull-ups, especially kipping ones, overhead squats, snatches, and shoulder-to-overhead moves like push presses can all irritate this tendon and cause persistent pain in the front of the shoulder. When any one of these conditions occur, the small muscles of the shoulder who have the responsibility of making the ball move perfectly within the socket sometimes fail to do so and even more pain occurs; this is termed “impingement syndrome.”
Sometimes the shoulder injury goes further than inflammation and is a tear of one of the structures. The rotator cuff tendons can tear away from their insertions into the bone (rotator cuff tear) and the labrum, which is a ring of cartilage that deepens the cup of the shoulder and helps provide stability can detach from the cup (labral tear or SLAP tear). These tears can occur suddenly with a major injury or gradually over time as an accumulation of repetitive trauma.
Sometimes the inflammation is associated with structural changes of the shoulder joint, resulting in wearing away of the cartilage over each surface of the bone, the formation of bone spurs, and eventually even reshaping or wearing away of the bony surfaces of the joint. Both the ball and socket joint of the shoulder (glenohumeral osteoarthritis) or the smaller joint between the collarbone and the lateral edge of the shoulder (AC joint arthritis) can be affected. This is usually determined by looking at an X-ray.
Back pain or injury in Crossfit is also typically an overuse problem but the sudden onset of severe back pain can occur and needs to be assessed by your health care provider. Muscle strain, inflammation of the supporting ligaments of the spine, irritation of the discs between the vertebrae, and inflammation surrounding the small nerves exiting the spinal cord are all sources of back discomfort. Typically icing, active rest, and physical therapy/directed home exercise are the initial treatments of choice for pain that has come on gradually without a sudden severe injury.
Crossfit knee injuries generally fall into the overuse category and respond well to activity modification (going lighter on squats, modifying or avoiding lunges or one-legged exercises such as pistols), ice, elevation, and compression. Although Crossfit does not generally involve a lot of agility movements (lateral, pivoting, or cutting motions), common Crossfit exercises like running, box jumps, double-unders, and squatting can all result in an injury to the cartilage of the knee most commonly seen in agility movements called a meniscus tear. This typically manifests as a focal, sharp pain in either the inside or outside part of the knee that occurs most frequently with twisting or flexion movements of the knee. Taking a break from exacerbating activities for a week or two is reasonable, but if these symptoms persist, it is best to seek evaluation with your health care provider.
There are a few other injuries that, while rare in general, tend to occur in the Crossfit population a little more frequently. Achilles tendon ruptures present suddenly and usually with a loud pop and a sharp pain in the back of the ankle. The history usually includes a variant of “I thought someone hit me in the back of the ankle with a baseball bat.” Bounding box jumps are the most common cause of this injury and modifying box jump technique to include pausing at the bottom before jumping back on top of the box will reduce the risk of this injury. Distal biceps tendon ruptures at the elbow where the tendon tears from its insertion into the upper forearm occur when a sudden and sometimes unexpected force is applied to a flexed elbow, causing the elbow to extend against resistance. Again, a pop is typically felt and/or heard in the elbow and the contour of the biceps muscle appears different than the unaffected side. Both Achilles and distal biceps tendon ruptures are typically treated with surgery, especially in active patients, and if you suspect you may have one of these injury, seek medical evaluation sooner rather than later.
My parting thoughts on Crossfit are these: Crossfit is neither safer nor more dangerous than any other fitness or workout option as long as you make safe choices. Loading up the barbell before you are well-versed in lifting technique, trying to keep up with your friend who has been doing Crossfit for five years and you just started three weeks ago, ignoring pain or limitations in your range of motion for the sake of completing a workout “as prescribed/Rx” all set you up for the likelihood of sustaining an injury. My advice: build up slowly and work within your abilities while striving to get a little better each day. Enjoy the endorphins and happiness that accompany getting sweaty and elevating your heart rate, developing your strength and endurance, and growing healthier with each workout. Injury is not a foregone conclusion with Crossfitting as long as you make smart workout decisions.
About Dr. Jurek:
Dr. Jurek is a board-certified orthopaedic surgeon who specializes in shoulder surgery and sports medicine surgery. In the OR, she enjoys repairing torn rotator cuff tendons (and all other tendons really), performing shoulder replacements, and fixing broken bones. She loves Crossfit but also enjoys dabbling in running, mountain unicycling, slacklining, surfing, and snowboarding. You can find her starting most of her mornings with a 5am workout at Rocket Crossfit in Seattle. Currently she is injury-free :).
*Note: this device is not yet available in the US.
It seems incredibly rare for someone to dream up a completely novel treatment for a complex, challenging orthopedic problem and have that treatment be less invasive, less risky to the patient, cost less than the accepted existing standard treatments, and provide excellent results with little downside. Read below to find out about one such case.
There is a new device that is being utilized in Europe and Israel (currently not approved by the US FDA and not available for sale in the US) to treat patients with massive, irreparable rotator cuff tears. Clinical trials are currently underway in the US with the hope that FDA approval will be forthcoming. This device is the InSpace balloon. I learned about this new device while attending a recent international conference on shoulder surgery; I have no affiliation with the device or its inventors/owners, I just think it sounds incredibly innovative, promising, and brilliant and I really wish I had thought of it :).
Some massive rotator cuff tears, due to poor tendon and muscle quality, will not allow a successful rotator cuff repair. The optimal treatment for massive rotator cuff tears is debated. There are many treatment options, all with their own risks and benefits. The exact choice of treatment depends on the patient’s problems, age, functional requirements and the surgeons’s preferences and experience. One recent development is the InSpace balloon. It is a low risk procedure and may have some benefits over traditional treatments.
The InSpace device is composed of an introducer and a balloon-shaped spacer made of a biodegradable polymer which is a widely used material in the medical industry. The spacer is positioned by an arthroscopic procedure in the subacromial space between the humeral head and the acromion. Once positioned, the spacer is inflated with physiological water to allow smooth and frictionless gliding between the shoulder bones (see the images below showing the position of the implanted balloon in relation to the bones and muscles).
As pain associated with the torn rotator cuff tendons may cause abnormal motion and limit rehabilitation, breaking the pain cycle may facilitate successful rehabilitation, allow pain relief, improve shoulder function, and potentially eliminate or defer the need for more extensive shoulder surgery. The spacer degrades within 6-12 months. While the spacer is intact in the shoulder, the patient proceeds with focused rehab, working to retrain their muscles to move the shoulder in such a way that pain is diminished and hopefully eliminated and function is optimized.
Some patients develop massive rotator cuff tears slowly over time and they are able to adjust their shoulder musculature to function much like an intact rotator cuff; centering the humeral head and powering the shoulder at the same time. These patients have remarkably painless and functional shoulders. The balloon gives the patient with a massive cuff tear who hasn't been able to compensate on his/her own the time to do so with the balloon doing the work of centering the head while the shoulder muscles retrain.
The InSpace Balloon is intended to decrease pain associated with ruptured tendons following a rotator cuff tear. It has been approved by the European authorities since July 2010.
The surgical procedure of InSpace balloon insertion is similar to other routine rotator cuff surgeries, conducted in an operating room, under general or regional anaesthesia using an arthroscopic approach.
European and Israeli surgeons are using InSpace in two situations: to buy several more years’ time for patients facing shoulder replacement surgery; and for patients with massive rotator cuff tears that cannot successfully be fixed surgically.
Through arthroscopy or mini-open surgery, InSpace can be implanted in under 10 minutes.
Dr. Chezar Avi from Emek Medical Center in Afula has implanted the device in patients with large unreparable tears causing significant pain, and in older patients seeking to avoid joint replacement surgery: “The biggest advantage is that the procedure is simple, done arthroscopically and the recovery is fast and fairly easy,” reports the surgeon. “Another advantage is that if it fails, you can always return and perform joint replacement surgery in the future.”
Clinical data collected by the device's parent company, OrthoSpace shows that approximately 85 percent of patients experience improvement in shoulder function after implantation, and that improvement gets better over time.
Clinical trials are currently underway in the US.
This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon.
The main focus regarding sports equipment safety is generally helmets. Other important protective equipment includes shoulder pads, chest protectors, shin guards, and protective eyewear; these also require proper fit, maintenance, and replacement when necessary
The CDC website is an excellent resource for information on helmet safety:
There are specific helmet fact sheets for specific sports:
The CDC website also has a link to download the free CDC HEADS UP Concussion and Helmet Safety app
Important Helmet Considerations:
Ensure good fit
Helmets should be cleaned regularly
Should be checked regularly for damage
Protect the helmet
Know when to replace a helmet
Football helmets have a 10 and Out Rule
Football helmets (among other types of helmets) can be reconditioned. This involves having an expert inspect and repair a used helmet by:
Bike helmets have a One Impact Rule
Labels are important. Look for labels that:
DISCLAIMER: All information contained on the seattleshoulderdoc.com website is intended for informational and educational purposes. The information is not intended nor suited to be a replacement or substitute for professional medical treatment or for professional medical advice relative to a specific medical question or condition.
Disclaimer: I am an avid runner and I admit to cherry-picking scientific research to advance the argument that running is AWESOME :).
I recently read a really interesting article by Gretchen Reynolds that shared new research findings regarding the benefits of running. I have summarized the article below:
I have a lot of patients who come to me with the worry that running ruins knees and is dangerous. They question whether they should continue down the destructive path or transition to something lower impact and safer like the elliptical trainer.
I am happy to report that a new study finds that running may actually benefit the knee, improving the biochemical environment inside the knee to keep things working (running :)) smoothly.
A popular argument is that running is dangerous to knees: the cumulative effects of impact on the knee from running inevitably results in slow wear and tear of the cartilage cushion of the knee, resulting in damage to the joint resulting in arthritis.
Thankfully, there is little evidence to support this argument and a growing body of evidence argues the contrary: epidemiological studies of long-term runners show that they are less likely to develop knee osteoarthritis than people who don't run.
Scientists posit that running may protect the knee because running is associated with relatively low body mass and carrying less body mass is known to reduce the risk of knee osteoarthritis. Some researchers question whether running may have a more directly positive impact on knee joints, perhaps by impacting the workings of various cells within the knee.
Researchers at Brigham Young University sought to find out the answer by recruiting 15 female and male runners under 30 years old without a history of knee injury or arthritis. The goal was to study people with healthy knees in order to better isolate running's impact on otherwise normal joints. The volunteers had blood drawn from an arm and then had a small amount of fluid (termed "synovial fluid") removed from their right knee. This fluid is a naturally-occurring fluid within joints that reduces friction through lubrication. Healthy knees contain only a small amount but arthritic or otherwise unhealthy knees contain much greater quantities of synovial fluid.
Next, the volunteers were transported via wheelchair to the university biomechanics lab where they either sat quietly for 30 minutes or ran on a treadmill at their preferred running speed for 30 minutes. Following their respective 30 minutes of sitting or running, they were again wheeled to the clinic where blood and synovial fluid draws were again performed. Each volunteer completed both a sitting and a running session on separate days.
Once the blood and synovial fluid draws were complete, the researchers investigated a variety of substances within the young runners' blood and synovial fluid. They focused particularly on molecules associated with inflammation because low-grade inflammation has been associated with the development and progression of arthritis.
The researchers looked for changes in the levels of several types of cells that are known to either increase or diminish the amount of inflammation within the knee. They also looked for changes in the level of a substance known as cartilage oligomeric matrix protein (COMP) which is often used as a marker of incipient or worsening arthritis. Compared to healthy knees, knees with arthritis can have about five times as much COMP in their synovial fluid.
Unfortunately, it turned out to be technically difficult to safely extract much synovial fluid from these healthy knees and the scientists wound up with complete numbers in only six out of the thirty runners.
But that being said, the data were interesting and consistent. In nearly every case, the runners' knee showed substantially lower levels of two types of cells that contribute to synovial inflammation, compared to their baseline levels. The runners showed a shift in their COMP: they had more of the substance in their blood and less in their synovial fluid. It seemed that running had squeezed the inflammatory substance out of their knee and instead into the blood.
Meanwhile, sitting resulted in slightly increased levels of COMP inside the knee and also raised the concentration of one of the inflammatory molecules.
Overall, these findings indicate that a single 30-minute session of running changes the interior environment of the knee, reducing inflammation and diminishing the level of a marker of arthritis.
An unexpected finding of the study is that sitting for 3o minutes also changes the interior environment of the knee, a finding that the authors of the study had not expected. Sitting seems to make the knee more biochemically vulnerable to later disease.
The lead author, Dr. Robert Hyldahl, professor of exercise science at BYU, notes that this study is very small and short-term. He would prefer to repeat it on a much larger scale "once we figure out how to get more synovial fluid" safely from healthy knees.
Dr. Hyldahl and his colleagues also hope to study longer running distances and various paces to see how these variables affect change within the knee. They also hope to recruit older and injured runners whose knees might have begun to respond fundamentally differently to the act of running than the joints of healthy people in their 20s.
Despite the limitations of the study, the lead author notes that the findings argue that moderate amounts of running are not likely to harm healthy knees and likely offer protection against joint damage.
I want to share a terrific article explaining the benefit of high-impact exercise. I have had countless patients ask me if it is best to continue running and participating in other high-impact exercises or if it would be better to cut back and strictly embrace more gentle types of exercise; this article certainly makes a case for the former and I talk with my patients frequently about its findings and recommendations.
This article by Gretchen Reynolds provides a compelling argument as to why we should continually participate in exercises that jar our bodies. I've summarized its content below.
A study by researchers at the University of Bristol found that athletes who experienced impacts of 4.2 G's or greater had significantly sturdier hipbones than athletes who did not participate in exercises that reached that threshold. Exercises that generate enough force to achieve 4.2 G's include running a 10-minute mile or jumping up onto and off of a box that is 15 inches or higher. This study compels me to encourage all of my patients, especially my patients who are in their forties, fifties, and beyond, to pound the ground in order to strengthen their bones and (hopefully) prevent fragility fractures such as hip fractures.
Another study found that after four months of high-impact jump training (simply hopping in place), hip bone mineral density (BMD) could be improved in premenopausal women by jumping 10 or 20 times, twice daily, with 30 seconds of rest between each jump. This is exciting news for anyone looking to optimize their bone health and prevent injury organically through exercise.
As always, it is best to consult your physician before initiating a new exercise program and certainly this is the case with older individuals seeking to start a high-impact exercise program as the stress required to improve bone health may be too much for certain individuals' bodies and bones to handle, at least initially. This caveat also applies to those of us with joint troubles including arthritis.
I want to discuss a condition that I frequently diagnose and treat in my clinic and for which I have a particular fondness and focus within my orthopaedic surgery practice: shoulder arthritis. I have many patients who come to see me with shoulder pain who are a.) very surprised to find out that they have shoulder arthritis and b.) are even more surprised to find out that there are excellent treatment options available to treat shoulder arthritis.
The shoulder joint (termed the “glenohumeral joint” in medical nomenclature) is the third-most common large joint affected by degenerative joint disease (knee and hip arthritis are more common). There are multiple types of shoulder arthritis and all of these ulitmately result in a wearing away of the "cushion" of the joint, the smooth outer covering of the bone known as the articular cartilage. As the cartilage wears away, the protective space within the shoulder joint narrows and the cartilage becomes rough and frayed and eventually wears completely away. This results in the bones of the shoulder joint rubbing against each other, causing pain. Because of the increased pressure on the surfaces of the bone, there can be structural changes that gradually occur within the shoulder including the formation of bone spurs (termed "osteophytes") and changes of the shape of bones of the shoulder. Although there is no cure for shoulder arthritis, there are many treatment options available. The goals for treatment are to manage pain and to allow you to remain active.
Pain is the most common symptom of arthritis of the shoulder and it is exacerbated by activity. The natural progression is for the pain to worsen over time, although how rapidly the pain progresses is unique to each patient. With shoulder arthritis, the pain is typically centered deep within the shoulder and may intensify with weather changes. Patients typically describe their pain as a deep ache, which worsens with activity.
Other symptoms include limited range of motion, sensations of clicking, grinding, and or snapping with movement of the shoulder, and, as the disease process progresses, pain at night which causes significant difficulty with sleep.
Initial treatment of shoulder arthritis is nonsurgical and includes options such as:
If your pain from your shoulder arthritis is not adequately addressed with the nonoperative treatments above then surgery is the next treatment step and usually consists of shoulder replacement surgery. There are multiple different types of replacements available and I will spend a lot of time talking with you about which option is the most appropriate to address your specific situation.
Briefly, the replacement surgery options include:
If you are having shoulder pain, consider scheduling an appointment to find out what is causing your pain and the best treatment(s) for you.
Sara Jurek, MD